32nd Annual Meeting of the European Society for Pediatric Infectious Diseases in Dublin, Ireland

The 32nd European Society for Pediatric Infectious Diseases (ESPID) annual meeting was held in Dublin, Ireland, from May 6th to 10th, 2014. Since its founding in 1983, ESPID has grown to include almost 1200 members from Europe and, increasingly, from other continents. ESPID’s annual meeting provides an excellent forum for clinicians and scientists interested in the many aspects of infectious diseases including clinical practice, research, education and training and vaccinology to meet, network, learn and to enjoy the conviviality of the atmosphere. More than 2500 participants from 96 countries attended this year meeting, confirming ESPID’s position as a truly global pediatric infectious diseases meeting, the theme for which was “Pediatric Infection: The Global Challenge.” Through the work of the International Scientific Committee and the Local Organizing Committee, a program was developed that encompassed problems of the developed and the developing world, that broadened horizons through cutting-edge research presentations and, importantly, that informed daily clinical practice, thus striving to meet the ESPID goal “Excellence in Paediatric Infectious Disease.” ESPID aims to inspire, nurture, develop and educate the next generation of pediatric infectious disease investigators and clinicians. “Young ESPID” is a dynamic and important group within the ESPID membership who ensures that the voice of trainees and young investigators is well articulated and heard. The “Young ESPID” meeting took place just prior to the Educational Workshop and goals for 2015 and beyond were outlined. The very popular clinically oriented Walter Marget Educational Workshop, coordinated by Dr. Hermione Lyall (UK), brought together 12 experienced faculty members to provide an excellent educational day for trainees. On this occasion topics selected for in-depth discussion included central nervous system and respiratory infections, congenital and neonatal infections antibiotic resistance and difficult-to-treat organisms. There was also great scope for young investigators to present original work in the daily short oral abstract presentations, poster walks and poster presentations. Support and development of the young investigators was also the focus of the 6th ESPID Research Masterclass, organized by Dr. Pierre Smeesters (BE), supported by a faculty of ESPID senior and junior researchers and held immediately following the meeting. It provides opportunities for young researchers to present their studies in a collegial forum for analysis and discussion. The premeeting industry sponsored satellite vaccinology symposia, and facilitated robust discussion on many of the issues confronting those tasked with the development and harmonization of immunization guidelines. Topics covered during the course of 7 symposia included optimizing protection against the common bacterial pathogens including pneumococcus, meningococcus and pertussis, improving implementation of vaccine programs for influenza and human papilloma virus and further unraveling of respiratory syncytial virus pathogenesis to inform preventive strategies. In opening the meeting, Prof. Ron de Groot (NL), President of ESPID, spoke of the important contribution of ESPID in advancing pediatric infectious disease knowledge, through educational programs, talks and presentations at the annual meeting, and the informal networking facilitated by meeting. With a few carefully learned and well-chosen Irish words, he wished delegates an enjoyable stay and a productive meeting. Prof. Karina Butler (IRL), Congerence Chair, thanked delegates for taking time from their busy schedules to attend ESPID, highlighted their importance in making it a successful event. Success would be achieved if, through the meeting, delegates increased their own knowledge and understanding and, in turn, shared that knowledge with others on their return home. Mr. Oisín Quinn, Lord Mayor of Dublin, officially opened the meeting acknowledging the tremendous accomplishments in the field. He recognized the continuing challenges of emerging and re-emerging infections, the development of antimicrobial resistance and equity of access to care. He commended all those attending for their endeavors and concluded by warmly welcoming all to Dublin. An absolute highlight of the meeting was the opening session. Prof. Mike Ryan, the World Health Organization (WHO) Middle East Polio Response Coordinator and Adjunct Professor of International Health, University College Dublin, presented a compelling “Report from the Front—responding to infectious disease threat.” Prof. Ryan took us on a whirlwind tour, showing how microbes, the dominant life force on earth, have shaped our history. From plagues and pestilences of the middle ages through the 1918 influenza pandemic to current-day threats, he examined the drivers of pandemic infection from the emergent, often zoonotic outbreak, through epidemic amplification, fuelled by population density, displacement and poverty and ultimately disease propagation facilitated by rapid transit of people, animals and animal products, that can culminate in pandemic disease. He reviewed the lessons from severe acute respiratory syndrome (SARS), their application in the context of the emergence of the Middle East respiratory syndrome coronavirus and outlined the real challenges to containment presented by Ebola. The global challenge of infectious diseases has never been more apparent. From the global to the local, Prof. Fergus Shanahan, University College Cork, Ireland, dwelt on an entirely different side of the microbe–host interaction in his talk “The microbiome: controlling us or controlling them.” Links between gut microbiota, host metabolism, inflammation, chronic disease and obesity were explored. The tantalizing prospect that, through manipulation of gut microbiota, we might be able to control susceptibility to a wide array of inflammatory, metabolic and neoplastic disorders was discussed. This very exciting area of research is clearly ripe for translation to the clinical setting. Scheduling a biochemical talk for an early-morning session might seem foolhardy and guaranteed to send delegates back to sleep. Such was not the case as Prof. Luke O’Neill, Trinity College Dublin, Ireland, gave a riveting talk, which was appreciated even by the most biochemistry averse. In “Future Concepts in Microbial Defence,” Prof. O’Neill guided us through the unraveling of understanding of metabolic pathways important in the control of inflammation. Much of this science originated in Prof. O’Neill’s own laboratory, which as he cheerfully pointed out lay only a 5-minute walk from the podium. The audience were reintroduced to the Warburg effect, that is, the shift from oxidative phosphorylation to aerobic glycolysis. This shift, triggered by the interaction of bacterial lipopolysaccharide with TLR4, alters metabolite production to upregulate the inflammatory response. The system appears to be fairly tightly controlled by the dimeric enzyme PKM2, targeting of which could result in a shift from the proinflammatory to anti-inflammatory state. He continued with an animated presentation of the important role of the circadian rhythm and BMAL1, the master clock regulator protein, in the proinflammatory/anti-inflammatory balance and in determining responsiveness to bacterial lipopolysaccharide. Complex, though it undoubtedly is, understanding of such basic biochemistry and host metabolic response may be key, leading not only to better management of bacterial sepsis but also to control of the wider spectrum of inflammatory and autoinflammatory syndromes. Having drilled down to analyze drivers of the inflammatory response at the biochemical and molecular level, it was time to draw back and look at the macro picture. Prof. Zulfiqar A. Bhutta, Founding Director of the Center of Excellence in Women and Child Health at the Aga Khan University in Karachi, Pakistan, and the Robert Harding Inaugural Chair in Global Child Health at the Hospital for Sick Children in Toronto, Canada, spoke of the critical importance of maternal nutrition in child health. For many children there remain very basic simple unmet needs. Addressing food security and maternal nutrition would reap enormous dividends for child health and dramatically reduce morbidity and mortality rates associated with infectious diarrheal disease and pneumonia. Over the following 2 days delegates were confronted with many difficult choices. Fortunately for ESPID members many of the presentations are available on the ESPID e-learning site: espid.multilearning.com. Annual favorites at ESPID are the Literature Review and the Interactive Case Sessions. A multinational panel, Drs. Morven Edwards (US), Shai Ashkenazi (ISR), Saul Faust (UK), Gerben Ferwerda (NL) and Andrew Cant (UK), ensured that attendees were updated on all that is “hot” in the pediatric infectious diseases literature. Prof. Nigel Curtis (AUS) and Dr. Julia Bilicki (CH) challenged both the audience and the panelists with their case conundrums. The parallel sessions on pertussis and bacterial infection and on vaccinology incorporated state-of-the-art presentations as well as original abstract presentations. Prof. Jussi Mertsola (FIN) spoke of the clinical consequences of pertussis, Prof. Kingston Mills (IRL) reported on novel pertussis vaccine developments and Dr. C. Mary Healy (US) on the successes and failures of pertussis prevention strategies. Vaccination of women against pertussis, late in pregnancy, is safe and, when timed appropriately, can be effective in protecting vulnerable neonates from the most severe consequences of this infection. Challenges to optimizing vaccination in scheduling, use of additional vaccines and managing suspected, unexpected serious adverse reactions were explored in the “Hot Topics in Vaccinology” session by Prof. Adam Finn (UK) and Dr. Hanna Nohynek (FIN). A new introduction to ESPID this year was the Special Antimicrobial Session. Prof. Mike Sharland (UK), founder of the Antimicrobial Resistance and Prescribing in European Children project, has led the charge to generate solid pediatric data and to raise awareness in Europe. The project involved the development and implementation of novel neonatal and pediatric surveillance methods to monitor antimicrobial consumption and resistance in children’s hospitals and in primary care across Europe. ESPID provided an excellent forum for presentation of some of the outputs of this project. After individual presentations pertinent to the topic, Prof. Sharland was joined by Dr. Julia Bielicki (CH) of Young ESPID, Prof. Carol Baker (US), Dr. Rob Cunney (IRL) and Dr. Dominique Monnet (SWE) for round-table discussion on combating antimicrobial resistance in children. A complimentary session was the very practical special lecture devoted to the control of hospital-acquired infections, delivered by Prof. Simon Dobson (CA). At the 32nd ESPID in Dublin, broad arrays of topics were included with symposia and lectures relating to community-acquired and hospital-acquired infections, tuberculosis, fungal infections, tropical infections, HIV/AIDS and Kawasaki syndrome. I urge ESPID members to take advantage of the availability of webcasts from the meeting. You can hear Prof. David Burgner (AUS) lecture on the epidemiology of Kawasaki syndrome, its increasing incidence in industrialized countries and association with urbanization. He explored the case for a likely infectious etiology, possibly requiring the “double hit” of infection with more than 1 agent and examined the potential roles of host susceptibility and environmental exposure. Prof. Mike Levin (UK) in a scholarly presentation on its management indicated that it is now time to reconsider the current treatment paradigm, with earlier intervention and selective use of adjunctive steroid therapy for those at high risk of complications. Similarly the very popular presentations on tuberculosis diagnosis (Dr. Tom Connell AUS), treatment (Dr. James Seddon, UK), Bacillus Calmette-Guérin (BCG) vaccination and beyond (Prof. Nigel Curtis, AUS), invasive fungal infection (Prof. Emmanuel Roilides, GR), Aspergillus and mold infection (Dr. Andreas Groll, DE) and antifungal agents (Prof. Thomas Walsh, US) are now, or will soon be, available as webcasts or slide presentations. The global importance of tropical diseases was brought sharply into focus in Dublin with Prof. Peter Hotez (US) reminding us that this group of conditions— ancient diseases, endemic to the most poorly resourced areas of the world, often chronic and disabling, with higher morbidity than mortality and often stigmatizing and poverty promoting, the Neglected Tropical Diseases—affect at least one-sixth of the world’s population and account for 500,000 deaths per year. Remedies though often inexpensive are still not universally available. Systematic population-based programs, using combination pills to cover the most prevalent infections, can yield significant health dividends. Dr. Andrew Riordan’s (UK) “Tropical Diseases, Nontropical Locations,” Prof. Robert Sauerwein’s (DE) discussion on malaria and a symposium devoted to HIV/AIDS reflected the international focus of the meeting. ESPID is about building bridges, networking and information exchange. We were delighted to welcome our sister society, the Paediatric Infectious Diseases Society of America, who convened a special ESPID/Paediatric Infectious Diseases Society of America viral infection symposium. Drs. Shannon Ross (US) and David Kimberlin (US) covered the dynamic area of cytomegalovirus infection. Years after the sentinel study on ganciclovir as treatment for congenital cytomegalovirus, there remain uncertainties regarding which children to treat and for how long and temptation to treat all is strong. However, as ganciclovir is associated with the potential for serious toxicity, the importance of awaiting the outcome of well-designed, randomized controlled trials to correctly inform practice was stressed. Dr. Mark Denison (US) on emerging coronaviruses and Dr. Ravi Jhaveri (US) on Hepatitis C infection completed the session. The interest generated was reflected in the very active audience and panel discussion that ensued. Following on the success of the ESPID/WHO symposium in Milan 2013, ESPID 2014 hosted a WHO symposium convened by Dr. Robb Butler. Dr. Eli Somekh (ISR) discussed the re-emergence of Polio and roll-out of the vaccination campaign in his country. Dr. Noni MacDonald (CA) spoke of the key role of health care workers in tackling vaccine hesitancy. A theme echoed very strongly in the Bill Marshall Lecture and again in the closing plenary. The Conference of Meningitis Organisations is an international member organization that brings together patient groups, health professionals and organizations and survivors and families, dedicated to the prevention of meningitis worldwide. The Conference of Meningitis Organisations symposium “The power of the patient voice: an essential ingredient to influence change” was a new engagement for ESPID. Allied to it was a very graphic portrayal of the effects of meningitis in a series of meningitis survivor portraits by renowned photographer Anne Geddes. This thought-provoking work served as a stimulus to all working to prevent these conditions. The final afternoon served as a memorable climax to the meeting. The “Best of ESPID” is always a highlight, wherein the present and future stars of the society can shine. This year a new award “The Education and Communication Award” reflecting the Society’s prioritization of efforts in this area found a just recipient in Prof. Mike Sharland, Professor of Pediatric Infectious Diseases at St. George’s Hospital in London (UK). Three ESPID fellowships were awarded: one to Dr. Aspasia Katragkou (GR) to undertake “A metabolomics-based investigation of antifungal therapy against Candida albicans” at the Weill Cornell Medical Center, NY, USA, and a second to Dr. (IRL) to research into the of the effects of in in the of Prof. Nigel Curtis in Dr. not only the ESPID award to study “The of intervention on the microbiota, and vaccine in but also an ESPID Young award for on risk in children and “The A second young Dr. de was for his work on and analysis of the of human few delegates who to prior to the final session will out to be a truly Prof. Pierre of the University of selected by the Society to The Bill Marshall the Society’s the with his most talk in in He highlighted the that of vaccination in improving the that available vaccines are we to new we are not the of safe and effective in of vaccine diseases the of a critical of of vaccination across health care and could reduce the to There is for a as to the and the of A vaccine in one but not can that that vaccine is important or There is an for international such as ESPID, to take the in this The key role of the health care in determining vaccination was also The between health care of vaccination and vaccination is well Addressing the vaccination training of and health care workers could health care workers to about vaccine and their own and security vaccination and thus ultimately vaccine Vaccination education not be to or training of health care but out into our with educational programs for even at the primary This talk was the to the session. An Prof. Professor of at the College of and of University and President of the Prof. The Cornell Professor and of at University and Prof. Professor of at the University of joined on the to the real that, in the of who the are to With success just a a in the of of with to in has This with only very of in the almost all of which are to from other including from Europe. and poverty and population displacement all the challenge us in the of these infections but with in efforts focus on the population and increasing vaccine better than Prof. who with to develop the Prof. with his role in the development of and Prof. who has to vaccine to us and to for a of Prof. reviewed vaccine development and its with the successful of endemic in the Prof. outlined the congenital syndrome be an for the virus is to the human the vaccine is and effective and can be with vaccine for a Prof. in a presented the clinical of its on children and their families, its and the of the associated morbidity and There are of some even in countries in the developed these diseases, and can be has been by the of endemic disease in the It is an not to be concluded the meeting with a real to to the strongly of vaccination and to efforts the of vaccine disease with and congenital syndrome. were challenged to their and to with their organizations and with ESPID in this The daily was with early-morning and late for is also Following the opening session ESPID hosted a welcome for all with a most presentation by to an This Irish and in a very and served as a great welcome to Dublin. The theme was in as the following faculty and were to a of the of and the Trinity College as in the to the to in the On the final the Society took place in most and as following the many took to the with our very own of an Irish With ESPID 2014 it now for to the President and the for their the International Scientific and the Local Organizing Committee, the very excellent most the delegates and of course the ESPID has grown as a The meeting now the of pediatric infectious disease I urge to us next year as Drs. and have an exciting program for ESPID 2015 in May I to

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